ESWL加自拟排石汤治疗复杂性肾结石16例

泌尿系结石是泌尿外科常见疾病,复杂性肾结石是泌尿外科治疗难题.我科采用ESWL加自拟排石汤治疗本病16例,疗效显著,报告如下: 1 资料与方法 1.1 一般资料 16例中男9例,女7例,年龄23～58岁.结石形状为铸型结石1例,鹿角形结石12例,巨大型结石(直径超过3cm)3例;单个结石10例,多发结石6例;左侧8例,右侧 6例,双侧2例.碎石前所有病例均行B超、KuB+ivP或RP检查,总肾功能异常6例,血肌酐最高250μmol/L,部分肾盏轻、中度扩张13例,重度扩张2例,尿常规中WBC(+～+++)8例.临床表现为患侧肾区隐痛、胀痛不适或伴有镜下血尿.     

中西医结合治疗对体外震波碎石后结石排出时间的影响

目的观察中西医结合疗法应用于体外震波碎石术(ESWL)后泌尿系结石的临床疗效。方法 120例泌尿系结石病人分为3组,西药组以黄体酮注射和双氢克尿噻治疗,中药组以排石验方加减治疗,中西联用组以西药联合中药治疗,观察治疗前后结石排出时间。结果中西联用组结石排净时间及排石总时间均少于单用西药和中药组(P0.05)。结论中西药联用配合体外震波碎石治疗结石疗效显著。     

Endoscopic treatment for chronic pancreatitis: indications, technique, results

Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and long-term relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.     

体外冲击波治疗上尿路结石并发症分析

目的分析ESWL治疗上尿路结石的术后并发症及处理。方法回顾性分析上尿路结石3014例。男1782例,女1232例。年龄14～65岁,平均年龄35．5岁。肾结石1158例,单发887例,多发271例（含鹿角形结石165例）：输尿管结石1856例（含双输尿管结石210例）。结果3014例尿路结石中,碎石有效率为75％,三个月排净率为92％。输尿管结石碎石成功率高于肾结石（77．5％对71％）,513例经1~4次复振后完全排净,229例由于“石街”过长梗阻严重或碎石无效,最后改输尿管镜碎石或、腹腔镜取石、PCNL取石和开放手术。术后常见并发症为血尿、皮肤红斑和皮肤破损、恶心、呕吐、肾绞痛,严重并发症为感染发热和肾周血肿。结论ESWL是治疗上尿路结石的一种有效和安全的方法,其并发症多较轻,可以预防和治疗。     

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones

Objective To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. Patient and methods We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. Results The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P = 0.17). For the group with stones <100 mm2, the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P = 0.12) and the proximal ureter group (P = 0.96), it adversely affected SFR in the distal ureter (P = 0.017). Conclusions ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm2. Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.     

Efficacy of expulsive therapy using nifedipine or tamsulosin,both associated with ketoprofene,after shock wave lithotripsy of ureteral stones

Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main treatments for ureteral stones. Some studies have reported the effectiveness of pharmacologic therapies (calcium antagonists or alpha-blockers) in facilitating ureteral stone expulsion after ESWL. We prospectively evaluated the efficacy, after ESWL, of nifedipine on upper-middle ureteral stones, and tamsulosin on lower ureteral stones, both associated to ketoprofene as anti-edema agent. From January 2003 to March 2005 we prospectively evaluated 113 patients affected by radiopaque or radiolucent ureteral stones. Average stone size was 10.16 ± 2.00 mm (range 6–14 mm). Thirty-seven stones were located in the upper ureter, 27 in the middle ureter, and 49 in the lower ureter. All patients received a single session of ESWL (mean number of shock waves: 3,500) by means of a Dornier Lithotripter S (mean energy power for each treatment: 84%). Both ultrasound and X-ray were used for stone scanning. After treatment, 63 of 113 patients were submitted to medical therapy to aid stone expulsion: nifedipine 30 mg/day for 14 days administered to 35 patients with upper-middle ureteral stones (group A1) and tamsulosin 0.4 mg/day for 14 days administered to 28 patients with stones located in the distal ureter (group A2). The remaining 50 patients were used as a control group (29 upper–middle ureteral stones—B1—and 21 lower ureteral stones—B2—), receiving only pain-relieving therapy. No significant difference in stone size between the groups defined was observed. Stone clearance was assessed 1 and 2 months after ESWL by means of KUB, ultrasound scan and/or excretory urography. A stone-free condition was defined as complete stone clearance or the presence of residual fragments smaller than 3 mm in diameter. The stone-free rates in the expulsive medical therapy group were 85.7 and 82.1% for the nifedipine (A1) and tamsulosin (A2) groups respectively; stone-free rates in the control groups were 51.7 and 57.1% (B1 and B2, respectively). Five patients (14.3%) in group A1, 5 (17.8%) in group A2, 14 (48.3%) in group B1 and 9 (42.8%) in group B2 were not stone-free after a single ESWL session and required ESWL re-treatment or an endoscopic treatment. Medical therapy following ESWL to facilitate ureteral stone expulsion results in increased 1- and 2-month stone-free rates and in a lower percentage of those needing re-treatment. The efficacy of nifedipine for the upper-mid ureteral tract associated with ketoprofene makes expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for ureteral stones.     

体外冲击波碎石疗效的影响因素及对策

体外冲击波碎石技术是目前各种泌尿系结石治疗方法中的首选,但在体外冲击波碎石过程中经常会出现影响治疗效果的各种因素：由于元器件质量问题、安装问题、老化问题等,造成性能参数发生变化,影响冲击波能量的发生、传导、聚集;人体本身的肥胖、胃肠积气、腹式呼吸、结石的理化性质等因素,使能量传递不良、聚集不良、效率变差。文中列举和分析了各种影响疗效的因素和原因,并提出了相应的解决方案。     

ESWL治疗上尿路结石1792例的护理总结

目的：探讨体外冲击波碎石（ESWL）治疗上尿路结石的护理方法。方法：回顾总结分析ESWL治疗上尿路结石1792例的术前宣教与术后观察护理。结果：详细手术方法宣教,可解除患者的心理压力,肠道准备可为碎石提供条件。结论：术后对症指导与观察能避免并发症的发生与发展。     

微创经皮肾镜取石术在输尿管上段结石治疗中的应用研究

目的 探讨微创经皮肾镜取石术治疗输尿管上段结石的疗效.方法 回顾性分析我院2007年1月～2008年4月采用微创经皮肾镜取石术治疗的33例输尿管上段结石患者的临床资料.结果 本组所有患者均一次穿刺成功,一期手术成功30例,3例二期手术成功.无中转开放手术病例,无术中大出血,无结肠、胸膜、腹膜及其他脏器的损伤.术后5～7d复查KUB,结石清除率为87.9%(29/33),残留结石经ESWL治疗1～2次,术后1个月复查排石率为100%.全部患者均治愈出院,术中、术后均未出现严重并发症.结论 PCNL治疗输尿管上段结石具有损伤小、恢复快、住院时间短、结石清除率高、并发症少等优点,是治疗复杂性输尿管结石的较好方法.     

ESWL治疗输尿管结石1430例报告

目的探讨ESWL治疗输尿管结石的方法。方法报告本院自2000年6月至2009年6月ESWL治疗输尿管结石的1430例临床资料。结果本组1430例输尿管结石均ESWL治愈。首次结石粉碎率为88．2％。再次复治率为11．77％,2周内结石排净率为95．2％,1月内结石排净率为100％,ESWL治疗3个月复查BUS、KUB及VIP未发现结石复发,治疗前有积水征象完全消失,均获得随访1年未发现ESWL术后高血压,输尿管周围纤维化等并发症发生。结论ESWL治疗输尿管结石具有经济、微创、方便可靠可作为治疗输尿管的首选方法。